Bottom Line:
Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms.Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response.We report a case in an immunocompetent female patient.

ABSTRACTMalignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.

Mentions:
A female patient, 29 years old, presented with a two weeks history of aclinical-dermatological picture characterized by the presence of fever, loss of appetiteand myalgia, soon followed by the onset of skin lesions like pustules and nodules thatprogressed to ulcers. Except for psoriasis, she did not present other comorbidities. Thephysical examination showed that the patient was in apparent satisfactory generalcondition, afebrile and with multiple lesions as nodules, ulcerated nodules and ulcers,the latter with a necrotic aspect, sometimes covered by scabs. The lesions were mainlylocated on the face, thorax and upper limbs (Figures1, 2 and 3). The palms had sparse lesions of small diameter, erythematous, discreetlyinfiltrated and with a collarette of scales surrounding them. There were no lesions onoral or genital mucosa, but in the perianal region and along the intergluteal cleft asingle, longitudinal ulcerated papulonodular lesion could be observed, compatible with acondiloma lata lesion. The ophthalmological and neurological examination did not revealabnormalities. Serum investigation showed VDRL = 1/256, positive treponemal test andnegative serology for HIV, VHB and VHC infection. The histopathological examination ofone of the lesions showed epidermal ulceration, presence of hematic crust and denselichenoid lymphohistiocytic infiltrate rich in plasmocytes, which extended until thedeep dermis. The vessels presented endothelial tumefaction with walls permeated bypolymor-phonuclear cells and fibrin microthrombi. Anti-Treponemapallidum immunomarking with polyclonal antibody was positive, evidencingnumerous spirochetes (Figures 4, 5 and 6).

Mentions:
A female patient, 29 years old, presented with a two weeks history of aclinical-dermatological picture characterized by the presence of fever, loss of appetiteand myalgia, soon followed by the onset of skin lesions like pustules and nodules thatprogressed to ulcers. Except for psoriasis, she did not present other comorbidities. Thephysical examination showed that the patient was in apparent satisfactory generalcondition, afebrile and with multiple lesions as nodules, ulcerated nodules and ulcers,the latter with a necrotic aspect, sometimes covered by scabs. The lesions were mainlylocated on the face, thorax and upper limbs (Figures1, 2 and 3). The palms had sparse lesions of small diameter, erythematous, discreetlyinfiltrated and with a collarette of scales surrounding them. There were no lesions onoral or genital mucosa, but in the perianal region and along the intergluteal cleft asingle, longitudinal ulcerated papulonodular lesion could be observed, compatible with acondiloma lata lesion. The ophthalmological and neurological examination did not revealabnormalities. Serum investigation showed VDRL = 1/256, positive treponemal test andnegative serology for HIV, VHB and VHC infection. The histopathological examination ofone of the lesions showed epidermal ulceration, presence of hematic crust and denselichenoid lymphohistiocytic infiltrate rich in plasmocytes, which extended until thedeep dermis. The vessels presented endothelial tumefaction with walls permeated bypolymor-phonuclear cells and fibrin microthrombi. Anti-Treponemapallidum immunomarking with polyclonal antibody was positive, evidencingnumerous spirochetes (Figures 4, 5 and 6).

Bottom Line:
Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms.Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response.We report a case in an immunocompetent female patient.

ABSTRACTMalignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.